1. Coordinates administrative and financial components of financial clearance including, validation of insurance/benefits, medical necessity validation, routine and complex pre-certification, prior-authorization, scheduling/pre-registration, patient benefit and cost estimates, as well as pre-collection of out-of-pocket cost share and financial assistance referrals.

2.Manages service line, and/or complex multi-payer insurance verification and benefit eligibility validation and prior authorizations, including obtaining and completing documentation for pre-certification and referrals/authorizations.

3. Performs root cause analysis on no authorization denials.

4. Cross trains and provides guidance to team of financial clearance specialists in day-to-day operations

5. Maintains regular communication and follow-up with patients and families to keep them informed of clearance and self-pay matters.

6. Maintains regular communication and follow-up with program and department contacts regarding pending insurance, coverage, and other payment-related matters.

7. Develops denial mitigation strategies with staff in registration, patient financial services, and clinical areas, as applicable.

Work Experience

At least 2 years of healthcare revenue cycle, patient access, hospital or medical office experience. General customer service, retail or non-healthcare call center work does not count.

Hands-on experience with insurance verification and prior authorization or pre-certification: checking eligibility and benefits on payer websites or real-time eligibility tools, and submitting and following up on auth requests with payers.

Working knowledge of insurance plans, especially managed care (HMO/PPO, Medicare, Medicaid MCOs), and of benefit terms like copays, deductibles and coinsurance.

Knows medical terminology and has basic familiarity with CPT and ICD-10 codes.

Strongly preferred

Epic experience, especially Prelude/Cadence (registration and scheduling) or Epic authorization work queues

Experience getting clinical documentation from physician offices to support auth requests

Experience with patient cost estimates, collecting out-of-pocket costs up front, or financial assistance referrals

Can read a UB-04 and an EOB

This position is remote but will require to be in office based on need. You must reside near the location.